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Bone healing is achievable despite extensive wound dehiscence and wide plate and screws exposure in children
E Melhem1, W Bayoud1, I Ghanem1
1Department of Orthopaedic Surgery, Hotel-Dieu de France Hospital, Saint Joseph University, 166830 Beirut, Lebanon.
Insights
Extensive wound dehiscence in pediatric orthopaedic surgery can be managed conservatively. Simple wound care, without antibiotics or hardware removal, can achieve bone healing and soft tissue recovery.
Area of Science:
- Pediatric Orthopaedic Surgery
- Wound Management
- Bone Healing
Background:
- Extensive wound dehiscence with exposed hardware after pediatric orthopaedic surgery typically requires aggressive management.
- Standard treatments include debridement, lavage, secondary closure, or hardware removal with external fixation.
Purpose of the Study:
- To evaluate a conservative management approach for extensive wound dehiscence and hardware exposure in pediatric patients.
- To assess the efficacy of local wound care without antibiotics or immediate hardware removal.
Main Methods:
- Case series of three pediatric patients with exposed plates and screws.
- Management involved repetitive debridement and local wound care.
- No intravenous antibiotics, secondary closure, or immediate hardware removal were employed.
Main Results:
- Uneventful bone healing occurred in two cases, with progress in the third.
- Plate and screw removal was performed after bone healing in two cases, and due to chemotherapy needs in the third.
- Spontaneous soft tissue healing was observed in all patients.
Conclusions:
- Stable fixation can facilitate bone healing even with significant wound dehiscence and hardware exposure.
- Conservative local wound care may be a viable alternative to extensive surgical intervention.
Background:
Extensive wound dehiscence and wide plate and screw exposure in the early weeks following orthopaedic surgery in children is usually managed either by extensive debridement, lavage and secondary closure or hardware removal and external fixation.
Patients:
Three children with LCP plate and screws exposure were managed by simple repetitive debridement and local wound care without any IV antibiotics, nor secondary closure or hardware removal. All three cases occurred in the tibia, one following tibial osteotomy in lateral hemimelia with a long history of previous surgeries, one following wide excision of a tibial Ewing sarcoma with chemo- and radiotherapy, and the third following wide excision of a 12cm necrotic tibial segment due to chronic osteomyelitis. Bone healing was uneventful in 2 cases and was in progress in the case with the Ewing sarcoma. Plate and screws were removed in all cases, following an obvious bone healing in 2 cases, and forced by the need for chemotherapy due to the presence of lung metastases in the third case. Spontaneous soft tissue healing occurred thereafter.
Conclusion:
A stable fixation may lead to a good bone healing despite an extensive wound dehiscence and a wide plate and screws exposure with just a proper local wound care and without any major additional surgery.
Level Of Evidence:
Level IV.
